Summary of findings 6. Skills training versus standard care for both severe mental illness and substance misuse.
| SKILLS TRAINING compared to STANDARD CARE for both severe mental illness and substance misuse | ||||||
| Patient or population: people with both severe mental illness and substance misuse Settings: community and outpatient Intervention: SKILLS TRAINING Comparison: STANDARD CARE | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| STANDARD CARE | SKILLS TRAINING | |||||
| Leaving the study early: Lost to treatment Follow‐up: mean 12 months | 138 per 1000 | 196 per 1000 (28 to 1000) | RR 1.42 (0.20 to 10.1) | 122 (3 studies) | ⊕⊝⊝⊝ very low1,2 | |
| Adverse event: Death | 79 per 1000 | 12 per 1000 (2 to 112) |
RR 0.15 (0.02 to 1.42 |
121 (1 study) |
⊕⊕⊝⊝ low3,4,5 | |
| Substance use: Alcohol (C‐DIS‐R average score) Follow‐up: mean 12 months | See comment | See comment | Not estimable | See comment | See comment | Data were skewed and no estimate of effect was calculated between randomised arms. |
| Substance use: Drug (non‐alcohol) (C‐DIS‐R average score) Follow‐up: mean 12 months | See comment | See comment | Not estimable | See comment | See comment | Data were skewed and no estimate of effect was calculated between randomised arms. |
| Mental state | See comment | See comment | Not estimable | No data were available for analyses. | ||
| Social functioning*: Role Functioning Scale: scale 1 to 7 Follow‐up: mean 12 months | The mean assessment of functioning in the intervention groups was 1.07 higher (1.15 lower to 3.29 higher) | 47 (1 study) | ⊕⊝⊝⊝ very low6,7 | * Global state data were not reported. NOTE: the scale is 1 to 7 and the difference observed is not of clinical importance and is not statistically significant. |
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| Quality of life/life satisfaction ‐ not measured | See comment | See comment | Not estimable | ‐ | See comment | Neither trial measured general life satisfaction. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; | ||||||
| GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate. | ||||||
1 Risk of Bias: Rated as VERY SERIOUS: Blinding was not possible and performance bias may be present. It was unclear whether assessors were blinded and detection bias may be present. Attrition bias was a high risk in Hellerstein 1995 with 47% loss to follow‐up at 4 months and 64% at 8 months with no reasons for drop‐outs provided and not addressed in analysis. 2 Imprecision: Rated as SERIOUS: The event rate was low (zero events in one trial) with a wide confidence interval. 3 Risk of Bias: Rated as SERIOUS: The trial outcomes were self‐reported abstinence and there is no report of whether raters were blind to treatment allocation when assessing the participant's self‐report.
4 Inconsistency: this is not possible to evaluate as there is only a single study.
5 Imprecision: The single trial has a small sample size of 121 with very low event rates. The confidence interval crosses the line of no effect and appreciable harm. 6 Risk of Bias: Rated as SERIOUS: Blinding was not possible and performance bias may be present. It was unclear whether 7 Imprecision: Rated as VERY SERIOUS: The single trial has a very small sample size (N =47) and the confidence interval is wide.